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University of Utah Program
Write the first paragraph of your article here. Anatomic and Clinical Pathology Residency Program 'Comment 1' Quoted from studentdoctor.net pathology forum post by "Notsoanon". Originally posted in 02/2009: "Scutwork.com seems to be down, and SDN is on the up-and-up, so I’ll put my review of the Utah pathology program here. If you have any other questions, feel free to ask. "I’m a PGY3 Pathology resident at the University of Utah. My wife and I did the couples match Pathology/Anesthesia. We interviewed at 15 excellent programs from east to west coast and ranked Utah #1 for the strength of training in both fields. Neither of us has any regrets. "If you want to know the details of rotations I can give you them, but the highlights are: "Autopsy – With the exception of a surprisingly enjoyable month at the medical examiner’s office, you finish your autopsies in the first year, spread over 6 months. I got 53 autopsies, with 50 being the minimum for boards, pretty much perfect for me. Others have been less fortunate and had 70s. "AP/SurgPath – The first week of the first year is overwhelming, but because of senior residents and 3-4 Pathology Assistants in the gross-room, I was able to leave by 6:30 or earlier most every night. You alternate grossing days with microscope days (you will see what you gross plus more) and don’t have to go back in the gross room after a day at the scope. When you are a senior you have even fewer grossing days, more time at the scope and more ownership of cases. At Utah you will see rare and interesting cases. There are not many large hospitals in this region of the United States and people with unusual tumors and genetic conditions travel a long ways for medical care at the UofUtah. There is also a required 2-3 months of surgpath in a community practice group, which rounds things out. The one less than ideal situation in surgpath is weekend grossing. When you are on surgpath as a senior or a junior you come in every other Saturday morning to gross for about 5 hours. This was instituted because of the massive number of specimens the University ORs churn out into the wee hours Friday night. It was simply too much for the on-call resident to handle by themselves. So now, there is a PA, a surgpath resident and an on-call resident all grossing together Saturday morning until about 13:00. Teaching on the surgpath rotation is excellent. We have the prestigious old-guard faculty as well as a newer crop of subspecialized surgpath faculty. Surgical pathology offices are centralized and doors are open for you to show cases around. "CP: I’d have to write a book to cover all the CP rotations you can do at UofUtah & Associated Regional and University Pathologists (ARUP, which is run by the pathology department of the University of Utah). Check out ARUP’s web site: http://www.aruplab.com/ to just see all the tests we offer. It’d also serve you well, wherever you go for residency, to use the ARUP Consult website: http://www.arupconsult.com/index.html which covers vetted testing algorithms for different diseases. ARUP is on the bleeding edge of clinical test development and if you want to put in the time as a resident you could get some phenomenal research done without having to fight for funding. If research isn’t your thing, you’ll at least get a strong CP education and know what’s coming down the pipe in terms of molecular analyses in anatomic pathology: there are a number of molecular tests on paraffin embedded tissue currently offered for clinical use, and even more in development. This type of molecular and cytogenetic testing on surgpath specimens is going to be key for precise diagnoses during our practice lifetime. If you learn about it now, it won’t be such a drag when you’re 40 and in private practice and your gastroenterologists are asking you for help in interpreting the KRAS pyrosequencing. That’s my soapbox on that. On all of the CP rotations the emphasis is on you functioning as a medical director, not learning how to perform testing. As part of that emphasis at UofUtah, once you have your medical license (sometime in the PGY2 year you will receive it) you can moonlight as an assistant medical director. You’ll be paid and get some hands-on experience doing either administrative work, trouble-shooting, or sign-out. There are a few other moonlighting options available for path residents at UofUtah including editing ARUP Consult. Which segues into cost-of-living in Utah: your salary will go a long way. "Call: You start taking call in your first year, about 53 days total. CP and AP call are separate and about 50% of the time expect to be at the hospital late (past 19:00) for frozen sections on AP call. About 50% of the time on CP call you’ll get woken up in the middle of the night for a transfusion reaction, though all CP call is from home. PGY1s cover Thanksgiving and Christmas call, so after your first year, you’ll have those holidays free. You take progressively less call as you become more senior – I’ve had a string of months with only 2 – 4 weeknights of call. Weekend CP call is from home over the phone and AP call does involve coming in to gross on Saturday at the main hospital and Sunday at the Children’s hospital, which is a drag, but ultimately not too much work (usually home by 13:00 on both days). The PGY1s on autopsy alternate covering weekend autopsies, which are postponed to Monday whenever possible. "Fellowships: There are now Surgical Pathology, Pediatric Pathology, Cytopathology, Hematopathology, Medical Microbiology, Molecular Genetics and Clinical Chemistry fellowships at UofUtah. The Hematopathology and Molecular Genetics fellowships are stand-outs in their fields. If you don’t want to stick around Utah for fellowship you’ll be in a great position to get one elsewhere. This year’s graduating class is going to Stanford for surgpath, Johns Hopkins for surgpath, and UofUtah from hemepath and cytopath. My class has already secured followships for hemepath at Stanford, hemepath at UofUtah, dermpath at Geisinger and cytopath at UofVermont. Recent residents have gone to Mayo for dermpath, Duke for dermpath, Iowa for cytopath, Michigan for hemepath, etc. Everyone now does a fellowship before going into the job market and the majority of former residents are in private practice. "Clearly, I’m a UofUtah fan. I didn’t write this to self-servingly drum up respect for the program - I’ve already got my dream fellowship. I think the praise is well deserved by the faculty and the rest of the folks that contribute to resident training."Studentdoctor.net Pathology Forum. Posted 02/2009 by Notsoanon. 'Comment 2' Quoted from studentdoctor.net pathology forum post by "Notsoanon". Posted in response to this question: "Are you grossing every other day on AP? When/how long do you have to preview and write up cases before signout?" Originally posted in 02/2009: "Short answer is yes. The longer answer is you gross at most every other day. There are certain weeks during PGY1 surgpath when you are on a service with no grossing, like GI or neuro (PAs gross all of our biopsies). During senior surgpath you only gross every other day when you are on the “Large” bench (cases that fit into 5 cassettes or more), no grossing for smalls, GI or neuro - more time at the scope. I’m not a fan of grossing, so it works for me. Yes, grossing is important – garbage in, garbage out. But learning returns on grossing decline more rapidly than returns from scope time. Because of the volume we get, and the fact PAs save the rare stuff for the residents, you’ll learn to knock-out mastectomies, colectomies, thyroids, uterus BSOs and prostates like a robot, and get enough experience to be proficient with a laryngectomy, Whipple, cystoprostatectomy and occasional pelvic exenteration. "Preview time is in the AM, after morning conference (08:00-09:00). You’ll get the slides for the service you are on and preview them until the attending says “Let’s look at 'em.” The sign-out time varies, and sometimes there’s more than one per day. I’d estimate you usually get about 5-6 hours of preview time. Not enough time for an early PGY1 to finish looking at all of the slides on the service, and the attending usually picks up the slack. Senior residents can usually get through all the cases, dictating, with IHC ordered. Not a perfect situation, and we’ve been trying variations since I’ve been here, but it works alright. The biggest flaw is that you may see a difficult case at the scope that’s dependent on IHC, which comes out the next morning when you will probably be grossing. Fortunately the gross room is next door to sign-out offices, but it takes individual initiative to go look at the slides when you’ve got a few spare minutes. Alternatively, you could look at the IHC the following scope day (more common), but the case will already have been signed out and its variable whether an attending will have saved them for you or had them filed already (you could easily pull them from the filing cabinet, but again, it takes initiative). "The problem is even more pronounced for cytogenetic testing on tumors you’ve grossed. If it’s interphase FISH, the results will be out in a couple of days and you may be on another bench. If it’s metaphase FISH or karyotype you’ll definitely be on a different bench and maybe even another service. Follow-up on these results for individual cases is difficult. I’d be very interested to hear how other programs have dealt with these issues." "The skiing is excellent, but frankly none of the path residents go much more than 5-6 times a year. You have the time to go most every weekend, but most of us do other stuff. Sunday I was out for a day of dirt biking in the mud and snow and sand in the desert past Delle, UT: http://maps.google.com/maps?f=q&sour...=12&iwloc=addr There’s a lot to do here. Q: "How many total months of surg path do you do?" There are 9 required surg path months: three your first year, three your second and three more in either 3rd or 4th year. Most residents do a couple elective months in subspecialties. Q: "Are you on CP for 24 months?" Shoot man, I don’t remember how many total months I’ll be on CP, most residents do the minimum required or just over to be board eligible. CP and AP are spread over the 4 years. Q: "Who are the prestigious AP faculty?" The names in AP are Lester Layfield - best known in cytology, but he’s does a lot of surgpath as well, Robert McDivitt of breast pathology fame and Gary Ellis in head and neck pathology. That said, there’s a bunch of faculty that aren’t on the national stage but are excellent pathologists and teachers. These types are the unsung that keep a good department running (you probably know a few at your program). The faculty bios are at: http://www.path.utah.edu/about-us/faculty-lists though most haven’t filled anything in. Q: "Interviewed at 15 programs!..." Like I said, my wife and I were doing couples match. In retrospect it was 14 programs more than we needed to interview at, but we didn't want to get snookered." 'Comment 3' Quoted from studentdoctor.net pathology forum. Posted by "Notsoanon" in 02/2009 in response to this comment:"I heard residnets(sic) only see like 10 cases a week on surg path at Utah." "I haven’t been on the surgpath service in a while, so I asked around to get more specifics: you do two weeks in a row on each of the major benches: smalls and larges. That means you start your first Monday grossing, and finish your second Friday at the scope. This comes out to 2 days at the scope your first week and three days your second. There are 5 hours of preview, from 09:00 until 14:00. While on larges, the current PGY1 is able to complete 6-7 cases including dictation, measurements and synoptic reports – this is for large cases like colectomies, mastectomies, other resections for tumor. The attending will sign-out the cases the junior resident can’t get to, but makes an effort to give the junior the cases they grossed plus the more unusual cases. The current PGY3 on surgpath is able to complete previewing and dictations for the entire larges service load, which is about 13 cases on average, but can jump to 20 in a day. When the resident is on the smalls service, the number of cases they see in a day is much greater, but the total amount of glass they look at is less than on the larges service. "So, Britthumme was not totally off-base in accusing the residents at Utah of only seeing 10 cases a week. The PGY1 resident on their first week of the large service will have two days at the scope, 6-7 cases a day, so 12-14 cases in that week. However, the second week will have 3 days at the scope for 18-21 cases in the week. But really, it’s an “all-you-can-eat” service for the PGY1: if you’re faster at preview, you can see 13 cases a day. Plus, if you’re a glutton for the old-school all-hours residency, you’re welcome to stay late on a scope day (or a gross day for that matter) and see the cases you missed. "Basically, there's a lot of quality material for the small number of residents at Utah." 'Comment 4' Quoted from studentdoctor.net pathology forum. Posted by "Notsoanon" in 07/2009 in response to this comment:"What has happened to the Utah program? I always heard they were a good program, but this year all 5 residents that matched there this year are FMGs as well as 3 last year. What's going on? Has anyone heard anything recently? P.S. I'm not trying to start another FMG vs US grad discussion, just curious about the program at Utah." "Straight from Utah - we've got a great first year class. We filled our 5 spots and only went down to position 12 or 14 on our rank list of about 30. "It's true, we give a fair shake to FMGs, so if you're a star-performer getting the cold shoulder from other programs just because you're an FMG, take a look at Utah. If you're a marginal passer who thinks Utah will take you, you're out of luck whether you're an FMG or a US grad."Studentdoctor.net Pathology Forum. Posted 07/2009 by Notsoanon. 'Comment 5' Quoted from studentdoctor.net pathology forum post by "RyMcQ". Originally posted in 04/2007: "I finished the program a few years ago, so I'll chime in here. "Most of the residents are US graduates. 2000 was the only year in the past 25 that the program didn't fill. That year, two FMGs were accepted into the program (one by scrambling), but they are the only FMGs that I am aware of in the last 10 years or so. "The faculty also mostly consists of US med school graduates. The few foreign graduate faculty members were all excellent. "The program tends to be a little more competitive than average because Utah is a strong draw for some people. There are a wide variety of outdoor recreational opportunities nearby. Med school graduates in Utah are more likely to be married and have children, so some try to stay close to family when they might be competitive at the more elite programs. Mormon applicants from all over the country often have ties in Utah. (Mormons made up about a quarter to a third of the residents in my years, if you care.) "Unfortunately, the cost of living is not as cheap as it used to be. Housing costs are still sky high. It won't be as expensive as NYC, but it isn't as cheap as most Midwest towns. "The training is pretty good. It definitely could be better. Surgical pathology rotations at the University in the 3rd and 4th years didn't really allow residents to take the lead in working up a case, dictating it, and presenting it for corrections at sign-out, so everyone opted for rotations at the community hospitals. These are excellent rotations, but they aren't the caliber of a rotation at a solid academic center. That is a shame because there is plenty of good material at the University. "Residents from Utah get good jobs and fellowships, but I think that is more a reflection of the caliber of residents coming into the program rather than the program making them into stars. I base this on the fact that when I went to Iowa for fellowships, The 3rd and 4th year residents there were more solid in surgical pathology than I was as a 5th year resident. It's my fault, of course, but there are programs (like Iowa) that just won't let residents get away with any half-assed learning. Residents leaving Utah may have to endure more stress in the first year of a job or fellowship, but, like I said, the graduates do really well despite what is probably a slow start. "CP is excellent, but it's CP, right?"